Understanding suicide risk in youth means looking beyond the most visible signs. While some warning signals are clear, many are subtle, especially when distress is masked by other behaviors or traits like withdrawal or perfectionism. The earlier we’re able to notice shifts in functioning and emotional regulation, the more space there is to intervene while avoiding panic and minimizing shame.
Fear of the worst-case scenario can make the topic of suicide feel overwhelming or untouchable. But the real work of prevention begins well before a crisis emerges. It starts in the patterns we notice, develops with the questions we’re willing to ask, and thrives in the systems we create to keep young people connected to care. Since September is Suicide Prevention Month, part 2 of our blog series takes a closer look at suicide risk in young people.
Suicide Trends in Adolescents
Suicide is the second leading cause of death among youth ages 10 to 14, and the third leading cause for those between 15 and 24. Let that sink in.
In our previous blog, we shared some of the statistics behind these patterns and examined how the COVID-19 pandemic acted as a tipping point for many adolescents already struggling with mental health concerns. In the years since, rates of suicide-related thoughts and behaviors have continued to rise, and existing disparities have only grown wider. Recent data shows that nearly 20% of high school students report serious suicidal ideation, with close to 10% reporting a suicide attempt in the past year.
Is Self-Harm the Same as Suicidality?
Self-harm, or non-suicidal self-injury (NSSI), is often misunderstood. While it can be a risk factor for suicide, it’s not always a suicide attempt. Many young people who self-harm describe it as a way to regulate overwhelming emotions; self-injury can temporarily relieve emotional pain, even as it introduces its own risks. Even when there is no stated suicidal intent, self-harm should always be taken seriously, and as a sign that someone is in distress and may be struggling to access other coping strategies.
There is a strong association between suicidal ideation, suicide attempts, self-harm behaviors, and underlying mental health concerns in adolescents. Most young people presenting with NSSI, suicidality, or both meet criteria for at least one psychiatric diagnosis, often related to depression, anxiety, or trauma/PTSD. That overlap is important not because one automatically leads to another, but because the presence of multiple risk factors can compound distress and complicate recovery.
When providers assess self-harm, they evaluate not only the presence of the behavior but also its frequency and method, as well as the apparent or disclosed function. They may ask whether the intensity has increased over time, whether new or more dangerous methods have emerged, or whether the young person reports relief, shame, fear, or dissociation during or after the act. Understanding whether suicidal thoughts are present alongside self-harm is a critical part of risk assessment, but it is not the only one. The goal is to grasp what purpose the behavior is serving, and where support can interrupt that cycle.
For assessment tools and clinical guidance on how to evaluate risk and support adolescents experiencing suicidal ideation and/or self-harm, see this resource.
How Do You Talk About Suicide Without Making It Worse?
One of the most persistent myths about suicide prevention is the idea that talking about it might put the idea into someone’s head. Research shows the opposite. Asking directly, without using leading questions and without conveying a sense of panic, can reduce risk by creating an opening for connection. When a young person senses that an adult can hold space for the conversation without reacting with fear or anger, they are more likely to share honestly.
Effective prevention depends on this kind of dialogue. That might sound like:
- “Have you been thinking about hurting yourself?”
- “When things feel really hard, do you ever think about not being here?”
- “Have you had thoughts about ending your life?”
The goal is not to interrogate, but to give someone the language and permission to name what they might already be thinking. If the answer is yes, the next step is to stay with them. Not to fix or solve right away, but to keep them grounded and supported while figuring out what happens next.
What Does Suicide Prevention Actually Involve?
Prevention is not limited to clinical intervention, it happens through connection and a sense of being known.
That includes:
- Ongoing access to affirming therapy, particularly for neurodivergent, queer, or other youth that face cultural stigma, and whose experiences are often misunderstood or invalidated.
- Trusted adults who check in and listen without minimizing. While this can include parents or caregivers, it may also mean teachers or coaches, extended family, a doctor or a therapist, or other mentors and community members. In some cases the immediate family is not a safe or stable source of support, and young people need consistent relationships with reliable, present adults.
- School staff trained to notice and respond appropriately, not only through policy but through everyday moments of interaction and observation. Training that includes trauma awareness, mental health literacy, and cultural responsiveness can change outcomes.
- Peers who are equipped to speak up when something feels off. Peer education programs and student-led initiatives can help normalize mental health conversations and encourage help-seeking.
- Access to tools like safety planning and crisis support, which provide concrete ways to interrupt risk and increase a sense of control. These tools are most effective when introduced before a crisis point.
Safety planning is one of the most effective strategies for suicide prevention. It involves identifying warning signs, personal coping strategies, supportive contacts, and ways to limit access to lethal means. Safety plans are developed collaboratively and revisited regularly. They’re most effective when young people are active participants, not passive recipients of a plan written for them.
In clinical settings, providers use validated screening tools and structured assessments to determine what kind of support a young person might need. Sometimes that means a brief stay in a hospital or specialized program to ensure safety. In many cases, however, the next step involves increasing outpatient support to help stabilize risk without disrupting daily life.
Suicide Risk and How To Respond
Recognizing the role of identity and context is essential. Some groups of young people face greater vulnerability due to systemic and social factors, but any adolescent can be overlooked if adults aren’t equipped to notice emotional shifts, or are unsure how to respond when something feels wrong.
Who Is Most Vulnerable and Why
Some groups face elevated risk because their experiences are marginalized, misunderstood, or overlooked:
- LGBTQ+ youth, especially those without family acceptance
- BIPOC youth who face racism, cultural stigma, or lack of access to culturally responsive care
- Youth with a history of trauma, including abuse, neglect, or community violence
- Youth with untreated or misdiagnosed neurodivergence (e.g., autism, ADHD)
- Youth experiencing housing instability, family disruption, or poverty
Warning Signs of Suicidality
Understanding how risk shows up matters just as much as knowing who’s at risk. Common signs include:
- Talking or joking about death or wanting to disappear
- Withdrawing from friends, school, or activities
- Sudden mood improvement after a period of depression
- Giving away belongings or writing goodbye messages
- Increased risk-taking or substance use
How to Talk About Suicide
Knowing how to talk about suicide and when to act can make the difference between a missed moment and a meaningful intervention:
- Stay calm. Don’t dismiss or argue.
- Ask direct, open-ended questions without judgment.
- Remove access to lethal means if safety is a concern.
- Help them connect to professional care, even if they resist.
- Follow up. One conversation isn’t enough.
Suicide prevention that ignores social determinants of health or dismisses cultural nuance will fall short. Effective care depends on the ability to recognize multiple factors, and the courage to have conversations that may feel difficult.
What Comes Next?
Surviving a suicidal episode doesn’t mean the crisis is over. Many young people return to their daily environments with little acknowledgment of what they’ve just been through. Rebuilding trust after a crisis takes time; adults may fear that saying the wrong thing will trigger a crisis, adolescents may hesitate to speak freely to avoid panicked or heightened responses, and they may also feel over-scrutinized or monitored. This can lead to a sense of lost autonomy during a developmental period that naturally centers around gaining freedom and forming a stable sense of self. Families often need help during this process too, not because they’ve failed, but because holding fear without becoming reactive is emotionally exhausting.
These dynamics can make recovery feel fragile, even when there’s genuine care on all sides. Support after a crisis needs to be steady but flexible, to avoid the potential for isolation or suffocation. What matters most is safety planning, therapeutic support, being prepared to adjust expectations around school or extracurriculars, and family work, coupled with an intentional effort to allow for privacy and space. Grounded in education and awareness of risk and warning signs, this kind of follow-up builds on the early recognition and calm response that prevention depends on.
Crisis Resources
988 Suicide & Crisis Lifeline — Call or text 988 for 24/7 confidential support
The Trevor Project (LGBTQ+ support) — Text “START” to 678678 or call 1‑866‑488‑7386